Working in the Virus’ Shadow: SARS-CoV-2 18 April, 2020, 0209 Hrs

It has been some days since I wrote. Too many night shifts; the desire to simply fall into a bed and sleep is too great to be denied. But this morning, I write.

For the past several days I have been in our CoViD19 Unit; actually the Medical Surgical ICU that has become the home for our Patients infected with SARS-CoV-2, the virus that causes CoViD19. One never quite knows with whom one is speaking when working on that unit, as all of us are always masked: either surgical masks when walking through the hallways, or a face-shield and a filtered half-face mask, better than the N95 mask.

There are no white coats. All of us, nurses and physicians, wear blue scrubs, and when entering a patient’s room, we layer on an impermeable whole-body apron and gloves. There is no shortage of PPE in this ICU, at this time, but there is concern, always, of what tomorrow will bring.

Yesterday, while on shift for the CoViD19 Unit, we had about six patients with confirmed disease and another handful who are called PUIs – Persons Under Investigation. Over the past several weeks, the time required to obtain nasal swab results for SARS-CoV-2 has dropped from 7-10 days to 24-48 hours. This is hugely important as the symptoms for CoViD19 are so non-specific, that almost anyone with shortness of breath can be termed a “CoViD19 Rule Out”, meaning that they are in respiratory isolation on the Medical Floor or in the ICU in a negative pressure room until the study comes back. There are, as you might suspect, a very limited number of negative pressure rooms – rooms that suck air INTO the patient room and out through high efficiency filters into the atmosphere – into which the confirmed CoViD19 Patients must be placed.

Treatment is a problem. It seems that I spent 12 hours discontinuing antibiotics that had been prescribed for the group of SARS-CoV-2 Patients. Now, antibiotics are useless against viruses, but they were prescribed anyway. Why? Certainly not because the prescribing physician didn’t know this fact. No, it is/was because there is so little with which we can actually treat these patients. Hydroxychloroquine/azithromycin, zinc, are all useless – no matter what Trump and Giuliani blather on about; there are studies ongoing to determine if these have any positive effect. But at this time I, at least, don’t use them in my Patients; the data just aren’t there. There is promise with some of the anti-viral agents, but these are undergoing study. And the anti-IL6, anti-TNF-alpha agents are, additionally, promising. Promising, but the data supporting their use is limited.

Which leaves us with the antibiotics. My colleagues, I think, use these agents to be doing something; but this “something” doesn’t work, and there are, on occasion, serious side effects. So I discontinue them.

Working in this environment, in which we have limited treatment for a lethal disease, is heart rending. We say, we have said, that no one should die alone. But these fellow humans often do die alone; family members are not allowed into the hospital during this pandemic as they could become infected or infect others. Many of our Patients DO die alone.

Two CoViD19 patients – one still a PUI and the other confirmed positive – died while I was caring for them. Alone.

This pandemic is not just crushing our economy, reminding us of misery and unemployment not seen since the Great Depression. This pandemic does not only make clear the disaster of the inexcusable income inequality – also known as oppression of the working class – we have allowed to exist. This pandemic does not only show in stark terms the incompetence and inhumanity of Trump and his administration. This pandemic does not only show the folly of employment-based health insurance. This pandemic also – for all of these reasons – tears at the fabric of our society.

At least for this physician, exclamations that health care workers are “Heroes” ring hollow. We who work in health care are doing our jobs. We are frightened, but we continue on. We are angry, but we continue on. We are not heroes. I am not a hero. Heroes are a different category of person: Teachers are heroes; Single mothers working three jobs and raising her children are heroes.

The last time such fear related to infection was seen was at the beginning of the HIV/AIDS epidemic. Homophobia, sexism, and racism were ever-present at the beginning of that epidemic, not unlike what we see now. And made worse by a President who is, seemingly, genetically incapable of empathy, or even competence. One can be forgiven for hoping that the solidarity we so desperately need to overcome this natural (viral), and unnatural (Trumpian), disaster will – all talk of heroes and heroism aside – show itself. Solidarity, all caring for all, is precisely what has been, and is, demanded at this time.


About AJ Layon

AJ Layon was, for 28 years, at the University of Florida College of Medicine, in the Division of Critical Care Medicine, in Gainesville, FL. For the approximately 10 years until September 2011, he was Professor and Chief of Critical Care Medicine at UF; In September of 2011 he became System Director and Co-Chairman of Critical Care Medicine in PA; this ended in 2017. He served as a Physician in the Surgical Group with Médecins sans Frontières (MSF, Doctors without Borders) through 2018 and is presently an intensivist in Florida, struggling through the SARS-CoV-2 crisis. While his interests are primarily related to health care, health care reform, and ethical issues, as a citizen of our United States and our world, he will occasionally opine on issues of our "time and destiny". Follow on Twitter @ajlayon
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